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Docs agree on how to treat intersex patients

A new paper published in Pediatrics, a leading medical journal, could change the way physicians treat children born with ambiguous genitalia.

The "Consensus Statement on the Management of Intersex Disorders" stops short of recommending against surgery for intersex children, a position advocated by Cheryl Chase, founder of the Intersex Society of North America. But, in careful language, it does urge physicians and parents to consider the long-term implications of genital surgery.

"Parents now seem to be less inclined to choose surgery for less severe clitoromegaly," the statement reads. "Because orgasmic function and erectile sensation may be disturbed by clitoral surgery, the surgical procedure should be anatomically based to preserve erectile function and the innervation of the clitoris. Emphasis is on functional outcome rather than a strictly cosmetic appearance. It is generally felt that surgery is performed for cosmetic reasons in the first year of life relieves parental distress and improves attachment between the child and the parents; the systematic evidence for this belief is lacking."

In a profile of Chase in the New York Times Magazine, journalist Elizabeth Weil calls the consensus statement "a major victory for Chase." However, Weil argues that "making progress from here may prove extremely difficult" because Chase must convince parents, and not just doctors, to be comfortable with a wait-and-see approach. Chase advocates parents choose a gender for their intersex children, but hold off on surgery until the child is old enough to participate in the decision-making.

In October, ISNA and the Gay & Lesbian Medical Association sponsored the first Disorders of Sex Development (DSD) Symposium. In a letter announcing the conference, the organizations said this about the consensus document: "While certainly not perfect, the new standard incorporates many of the practices and ideas that ISNA has been recommending for over a decade. In addition to many valuable changes in the standard of care, the Intersex Consensus Group agreed to update the medical nomenclature, bringing intersex conditions into line with other genetic and endocrine disorders."

ISNA has recently published a pair of handbooks, one focused on the clinician and the other on parents, which offer detailed directions for providing patient-centered care for disorders of sex development. For more information, go to www.isna.org.

A copy of the consensus statement is available at http://pediatrics.aappublications. org/current, shtml. (New York Times Magazine, Sept. 24 and Pediatrics, Vol. 188, No. 2, August 2006)

CDC: Get a HIV/AIDS test

In a major shift, the Centers for Disease Control and Prevention (CDC) recommends that all Americans between the ages of 13 and 64 get tested for HIV/AIDS. Previously, only those thought to be at risk for contracting the disease were urged to get tested.

"Our traditional approaches have not been successful," said Julie Gerberding, CDC executive director and a medical doctor. "People who don't know their own HIV status account for 50 to 70 percent of all new infections. If they knew, they would take steps to protect themselves and their partners."

Despite widespread education on the topic, about 40,000 people are infected annually in the U.S. That number has not declined in recent years. (New York Times, Sept. 22)

Indonesian novels with sexual themes prove popular

Novels with sexual themes have become a huge hit in Indonesia. Known as "sastra wangi" (fragrant literature), books written by women for female audiences sometimes sell as many as 100,000 copies.

"Indonesian literature has taken a sharp turn in themes and authorship," said Mirna Yulistianti, an editor at a publishing house. "Women writers have started to come out with new styles and themes. Sexual liberation is the main theme in most of their works. …